Purinergic neurotransmission, involving release of ATP as an efferent neurotransmitter was first proposed in 1972. Later it was recognised as a cotransmitter in peripheral nerves and more recently as a cotransmitter with glutamate, noradrenaline, GABA, acetylcholine and dopamine in the CNS. Both ion channel and G protein-coupled receptors for purines and pyrimidines are widely expressed in the brain and spinal cord. They mediate both fast signalling in neurotransmission and neuromodulation and long-term (trophic) signalling in cell proliferation, differentiation and death. Purinergic signalling is prominent in neuron-glial cell interactions. Purinergic signalling has been implicated in learning and memory, locomotor activity and feeding behaviour. There is increasing interest in the involvement of purinergic signalling in the pathophysiology of the CNS, including trauma, ischaemia, epilepsy, neurodegenerative diseases, neuropsychiatric and mood disorders.